植入型心律转复除颤器不适当电击的发生特点及优化管理

The occurrence characteristics and optimal management of inappropriate shocks in patients with implantable cardioverter defibrillator

目的分析植入型心律转复除颤器(ICD)术后不适当电击的发生特点及处理方法。方法通过腔内心电图判定ICD不适当电击的发生原因,针对发生原因进行个体化治疗。结果在我科2011-2014年植入ICD的189例患者中,20例发生了不适当电击,发生比例约10.6%,心房颤动(AF)伴快速心室率、室上性心动过速(SVT)及过感知是主要原因。其中,70%(14/20)患者是由于AF伴快心室率进入了室颤的诊断区间,发生了不适当电击;15%(3/20)误将SVT识别为室速;10%(2/20)肌电干扰过感知是由于发生了电极导线故障;5%(1/20)T波过感知。17例调整药物治疗方案及ICD优化程控设置,2例植入起搏感知电极进行手术干预故障电极,T波过感知通过调整起搏电极的感知极性,均未再发生严重误电击事件。结论AF快心室率是引起不适当电击的主要原因,长期有效的药物治疗结合ICD鉴别诊断参数优化是主要的治疗方法,对于特殊病因需采用必要的手术治疗进行干预。

Objective To evaluate the occurrence characteristics and management of inappropriate shocks in imp]antable cardioverter defibrillator （ICD） patients. Methods The causes of inappropriate shocks were analyzed by reviewing the endoeardial electrocardio- grams, then the patients received the individualized treatment. Results Twenty patients experienced inappropriate shocks among 189 ICD patients （10.6% ,20/189）. Atrial fibrillation （AF） with high ventricuiar rate,supraventficular tachycardia （SVT） and oversensing were the main causes for inappropriate shocks. AF with high ventieular rate were involved in the diagnostic interval of ventricular fibrillation （VF） in 70% of the patients,which led to the inappropriate shocks. Three patients（ 15% ） underwent inappropriate shocks for misunderstanding SVTs to VTs, and two patients experienced the lead malfunction because of the eleetromyographical interference oversensing, and one patient had T-wave oversensing. Seventeen patients received adjustment of drug therapy and optimal program setting of ICD. Two patients underwent the interventional operations on malfunction leads by implanting an additional pacing/sensing leads. T-wave oversensing was handled by adjusting the sensing polarity of pacing lead, then no severe false shocks event reoccurred. Conclusion AF with high ventrieular rate is the main cause for inappropriate shocks. The long-term drug therapy combined with the optimal ICD differential diagnostic parameters is the main therapeutic method. For some special eases, the necessary interventional operations are required.